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What Are the Risks of Prophylactic Pinning to Prevent Contralateral Slipped Capital Femoral Epiphysis?

  • Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Two decision analyses on managing the contralateral, unaffected hip after unilateral slipped capital femoral epiphysis (SCFE) have failed to yield consistent recommendations. Missing from both, however, are sufficient data on the risks associated with prophylactic pinning using modern surgical techniques.

Questions/purposes

We determined the incidence and nature of complications after contemporary prophylactic fixation of the contralateral, unaffected hip in patients with a unilateral SCFE.

Methods

We retrospectively identified and reviewed 99 children (mean age, 11 years; range, 8–15 years) who underwent prophylactic pinning of the contralateral hip after treatment of a unilateral SCFE at four tertiary-care children’s hospitals from 2001 to 2010. Complications on the prophylactic side, such as avascular necrosis (AVN), chondrolysis, fractures, implant pain, and need for further surgery, were recorded. Minimum followup was 12 months (median, 26 months; range, 12–110 months).

Results

On the prophylactic side, we found two cases of focal AVN (2%) and no cases of chondrolysis (0%). Two patients sustained periimplant femur fractures (2%). Three patients had symptomatic hardware (3%), two of whom required surgery for implant removal. In three patients (3%), growth occurred off the end of the prophylactic screw before physeal closure, but they did not require revision fixation. No patients developed a subsequent slip on the side of the prophylactic pinning.

Conclusions

While prophylactic pinning prevents SCFE, it is not an entirely benign procedure. The possibility of developing complications such as AVN and periimplant fracture should be considered when determining the best management for the contralateral hip in patients who present with unilateral SCFE.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank Hassan Azimi, BS, University of Colorado School of Medicine, Denver, CO, USA, for his assistance with data collection.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Wudbhav N. Sankar MD & Ali A. Al-Omari MD

  2. Department of Orthopaedic Surgery, Children’s Hospital Colorado, Aurora, CO, USA

    Eduardo N. Novais MD

  3. Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Christopher Lee MD & Paul D. Choi MD

  4. Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, USA

    Benjamin J. Shore MD, FRCSC

Authors
  1. Wudbhav N. Sankar MD
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  2. Eduardo N. Novais MD
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  3. Christopher Lee MD
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  4. Ali A. Al-Omari MD
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  5. Paul D. Choi MD
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  6. Benjamin J. Shore MD, FRCSC
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Corresponding author

Correspondence to Benjamin J. Shore MD, FRCSC.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at the Children’s Hospital of Philadelphia, Philadelphia, PA, USA.

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Sankar, W.N., Novais, E.N., Lee, C. et al. What Are the Risks of Prophylactic Pinning to Prevent Contralateral Slipped Capital Femoral Epiphysis?. Clin Orthop Relat Res 471, 2118–2123 (2013). https://doi.org/10.1007/s11999-012-2680-1

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  • DOI: https://doi.org/10.1007/s11999-012-2680-1

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